Revisiting the role of surgery in the treatment of Graves' disease

Oded Cohen; Ohad Ronen; Avi Khafif; Juan P Rodrigo; Ricard Simo; Pia Pace-Asciak; Gregory Randolph; Lauge H Mikkelsen; Luiz P Kowalski; Kerry D Olsen; Alvaro Sanabria; Ralph P Tufano; Silvia Babighian; Ashok R Shaha; Mark Zafereo; Alfio Ferlito

doi:10.1111/cen.14653

Revisiting the role of surgery in the treatment of Graves' disease

Clin Endocrinol (Oxf). 2022 Jun;96(6):747-757. doi: 10.1111/cen.14653. Epub 2021 Dec 26.

Authors

Oded Cohen¹, Ohad Ronen², Avi Khafif³, Juan P Rodrigo⁴, Ricard Simo⁵, Pia Pace-Asciak⁶, Gregory Randolph⁷, Lauge H Mikkelsen⁸, Luiz P Kowalski^{9

10}, Kerry D Olsen¹¹, Alvaro Sanabria^{12

13}, Ralph P Tufano^{14

15}, Silvia Babighian¹⁶, Ashok R Shaha¹⁷, Mark Zafereo¹⁸, Alfio Ferlito¹⁹

Affiliations

¹ Department of Surgery, Division of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA.
² Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
³ A.R.M. Center of Otolaryngology-Head and Neck Surgery, Assuta Medical Center, Affiliated with Ben-Gurion University of the Negev, Tel Aviv, Israel.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, Oviedo, Spain.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
⁷ Division of Otolaryngology-Endocrine Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts, USA.
⁸ Department of Pathology, Eye Pathology Section, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
⁹ Department of Head and Neck Surgery, University of Sao Paulo Medical School, AC Camargo Cancer Center, Sao Paulo, Brazil.
¹⁰ Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo, Brazil.
¹¹ Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA.
¹² Department of Surgery, School of Medicine, Universidad de Antioquia-Ips Universitaria, Medellín, Colombia.
¹³ CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello-Clínica Las Vegas-Quirón, Medellín, Colombia.
¹⁴ Multidisciplinary Thyroid and Parathyroid Center, Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA.
¹⁵ Division of Otolaryngology-Endocrine Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Madison, USA.
¹⁶ Department of Ophthalmology, Ospedale Sant'Antonio, Azienda Ospedaliera, Padova, Italy.
¹⁷ Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
¹⁸ Department of Head & Neck Surgery, Anderson Cancer Center, Houston, Texas, USA.
¹⁹ International Head and Neck Scientific Group, Padua, Italy.

PMID: 34954838
DOI: 10.1111/cen.14653

Abstract

Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.

Keywords: Graves' disease; head and neck; hyperthyroidism; surgery.

Publication types

Review

MeSH terms

Antithyroid Agents / therapeutic use
Graves Disease* / drug therapy
Graves Disease* / surgery
Humans
Iodine Radioisotopes / therapeutic use
Thyroid Neoplasms* / surgery
Thyroidectomy

Substances

Antithyroid Agents
Iodine Radioisotopes